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Barteczko MLM, Orellana HC, Santos GRF, Galhardo A, Kanhouche G, Faccinetto ACB, Júnior HT, Pestana JOM, de Paola ÂAV, Barbosa AHP. Long-term clinical outcomes of patients with nonsignificant transplanted renal artery stenosis. BMC Nephrol 2022; 23:61. [PMID: 35135498 PMCID: PMC8826676 DOI: 10.1186/s12882-022-02691-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transplant renal artery stenosis (TRAS) is the main vascular complication of kidney transplantation. For research and treatment purposes, several authors consider critical renal artery stenosis to be greater than 50%, and percutaneous intervention is indicated in this scenario. However, there are no reports in the current literature on the evolution of patients with less than 50% stenosis. METHOD This retrospective study included data from all patients who underwent kidney transplantation and were suspected of having TRAS after transplantation with stenosis under 50% independent of age and were referred for angiography at a single centre between January 2007 and December 2014. RESULTS During this period, 6,829 kidney transplants were performed at Hospital do Rim, 313 of whom had a clinical suspicion of TRAS, and 54 of whom presented no significant stenosis. The average age was 35.93 years old, the predominant sex was male, and most individuals (94.4%) underwent dialysis before transplantation. In most cases in this group, transplants occurred from a deceased donor (66.7%). The time between transplantation and angiography was less than one year in 79.6% of patients, and all presented nonsignificant TRAS. Creatinine levels, systolic blood pressure, diastolic blood pressure and glomerular filtration rate improved over the long term. The outcomes found were death and allograft loss. CONCLUSION Age, sex and ethnic group of patients were factors that did not interfere with the frequency of renal artery stenosis. The outcomes showed that in the long term, most patients evolve well and have improved quality of life and kidney function, although there are cases of death and kidney loss.
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Affiliation(s)
- Manoela Linhares Machado Barteczko
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil.
| | - Henry Campos Orellana
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Gustavo Rocha Feitosa Santos
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Attílio Galhardo
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Gabriel Kanhouche
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Ana Carolina Buso Faccinetto
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Hélio Tedesco Júnior
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
- Division of Nephrology, Hospital Do Rim E Hipertensao, UNIFESP, São Paulo/SP, Brazil
| | - José Osmar Medina Pestana
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
- Division of Nephrology, Hospital Do Rim E Hipertensao, UNIFESP, São Paulo/SP, Brazil
| | - Ângelo Amato Vincenzo de Paola
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
| | - Adriano Henrique Pereira Barbosa
- Department of Medicine, Cardiology Discipline, Federal University of Sao Paulo-UNIFESP, Sao Paulo Hospital, R. Napoleão de Barros, 715 - Vila Clementino, Sao Paulo/SP, 04024-002, Brazil
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Artery Stenosis of the Renal Graft: Experience of a Center of Northeastern Brazil. Transplant Proc 2016; 48:74-80. [PMID: 26915846 DOI: 10.1016/j.transproceed.2015.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/17/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Transplant renal artery stenosis (TRAS), the most common vascular complication after transplant (Tx), leads to resistant hypertension, impaired renal function, and even loss of the graft. The purpose of the study was to investigate the prevalence and factors associated with TRAS in northeastern Brazil. METHODS The study was conducted as a retrospective case-control study in a population of Tx recipients in a renal Tx center in northeastern Brazil. Demographic and clinical characteristics of the recipients and donors, data related to the surgery, laboratory data, and number of anti-hypertensive drugs were assessed. Statistical analysis was performed with the use of SPSS 17.0. RESULTS A total of 494 of 529 recipients were assessed, of which 24 had TRAS. The prevalence of TRAS was 4.8%. Twelve patients (50%) were men with a mean age of 46.7 ± 13.5 years. The mean time of diagnosis was 89.9 days after Tx. The risk factors associated with TRAS were number of anti-hypertensive drugs ≥2 (odds ratio, 17.0; confidence interval, 4.1 to 70.4; P = .001) and grafting with 2 or more arteries (odds ratio, 8.9; confidence interval, 1.4 to 56.6; P = .021). There was a significant reduction in mean systolic blood pressure (147.1 ± 23.7 to 127.8 ± 15.2 mm Hg, P = .001) and diastolic blood pressure (86.6 ± 13.0 to 77.6 ± 9.4 mm Hg, P = .001) after TRAS repair and in serum creatinine (2.8 ± 2.4 to 1.9 ± 1.8 mg/dL, P = .04). CONCLUSIONS Grafts with 2 or more arteries are associated with TRAS, as well as patients who use a higher number of anti-hypertensive drugs. TRAS repair was associated with improved blood pressure control and renal function.
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Sousa WOD, Silva FHPD, Aquino Filho RJ, Paz DR. Endovascular treatment of external iliac vein stenosis caused by graft compression after kidney transplantation. J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.
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